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1. COMPARISON OF DRY EYE IN PRE
AND POST MENOPAUSE
BY:
KASHUF SHAKOOR (70086652)
AYESHA ARSHAD (70086651)
M. JABRAN AYAZ (70085566)
KAINAT AWAN (70086646)
RABIA KHALID (70088286)
SUPERVISOR: MISS HIRAANWAR
CO-SUPERVISOR: MISS SHARMEEN SHAHID

2. OUTLINE
 Introduction
 Literature Review
 Objectives
 Operational definitions
 Methodology
 Ethical considerations
 Data collection
 Data analysis
 Results
 Discussion
 Conclusion
 References
 Questionnaire

3. INTRODUCTION
 Dry eye is a multifactorial disease of ocular surface which
causes Discomfort, Visual disturbance and tear film
instability with potential damage to ocular surface.
Tear film consist of three layer:
•Outer most lipid layer secreted by meibomian gland.
•Middle watery layer secreted by lacrimal gland.
•Inner most mucin layer secreted by goblet cells of
conjunctiva.
3

4.  Dry eye can develop from many reasons in both males and females
such as
•Aging
•Medication
•Excessive computer usage
•Meibomian gland dysfunction
•Sjogren syndrome
•Autoimmune diseases
But women are more likely to develop the condition and one of the
reasons is Menopause caused by hormonal changes in them. It is a
natural process that occurs in women’s life after age 45 when her
period stops.

5. CONTINUED
Symptoms of DED include:
•Burning
•itching
•Foreign body sensation
• Decreased vision
•Sensitivity to light
•Eye redness
•Complexity wearing contact lens
•Complexity with driving at night time
•Blurry vision
•Tired eyes
•Watery eye

6. •To live with dry eye symptoms provoke feelings such as distress,
frustration and awkwardness.
•Sex hormones such as Estrogens are believed to causes dry eye
while Androgens help in maintaining structure and function of
meibomian and lacrimal glands, therefore androgen deficiency
plays a role in etiology of dry eye.
•In the pathophysiology of dry eye disease, low androgens levels
are most consistent hormonal factor.

7. •If left untreated it can cause conjunctival scarring or corneal
complications in later stages.
• In addition filamentary keratitis, ulceration or even corneal
perforation can cause serious complications
•So it is very necessary to find the relationship between
menopause and dry eye.

8. LITERATURE REVIEW
 Jeena Gurung et, al. conducted a study From
April 2017 to March 2018 :
It was found that (66%) of postmenopausal
women had dry eye. Among them, from the
OSDI scoring system, 26% had reasonable dry
eye, 19% had strict dry eye as well as 21% had
mild dry eye
8

9. LITERATURE REVIEW
 A study examined 1508 individuals having age
more than 50 years by Enrique O Graue-Hernandez
et, al in 2018.
 the aim of this study was to determine the
prevalence of dry eye symptoms
 They concluded that Prevalence of Dry eye syndrome is
high and associated with menopause, gender, smoking
and hypertension medication.
9

10.  In 2018, cross sectional descriptive study was conducted by Dr. Surabhi
Beniwal et al on occurrence of Dry eye in premenopausal as well as
postmenopausal women.
 Study population consist 75 premenopausal and 75 postmenopausal
women.
Results showed that:
Out of 75 postmenopausal women examined, 31 patients (41.33%) had
dry eye
 Out of 75 premenopausal examined, 3 patients (4%) had dry eye.
According to the severity of dry eyes, commonness of mild dry eyes was
greatest (21.33%) and harsh dry eye was smallest amount (8%).

11. Literature Review:
 A study was conducted by Travis peck et al in june
2017:
• Aim of study was to check role of sex hormones in dry
eye disease (DED) on post-menopausal women. .
• They concluded that alteration of sex hormone plays an
important role in pathophysiology of dry eye disease in
premenopausal and menopausal group

12.  Cronellius Gananduraj et, al. performed a investigation in 2019
on 200 post menopausal women.
Modification of sex hormones played significant role in
pathophysiology of DED in premenopausal as well as
menopausal age group.
They concluded that the occurrence of dry eye in post-
menopausal women was 52%.It was establish that the
occurrence of dry eye rises with age from 26.8 % (50-54 years)
to 85.7% (>70years).

13. OBJECTIVE
 To determine the frequency of dry eye in pre
and post-menopausal women..

14. OPERATIONAL DEFINITIONS
 Tear film:
 Tear film is unique thin fluid layer of approximately 3micro meter thick and 3
micro liter in volume that covers the outer mucosal surfaces of the eye. As such
it is the interface of the ocular surface with the environment.
 Dry eyes:
 Dry eye disease is a common condition that occurs when your tears are not able
to provide adequate lubrication for your eyes. Tears can be inadequate and
unstable for many reasons. For example dry eyes may occur if you don’t
produce enough tears or if you produce poor-quality tears.
 Menopause:
 It is the time in a woman’s life when her periods stop. It usually occurs naturally,
most often after age 45. Menopause happens because the woman’s ovaries stop
producing the hormones estrogen and progesterone. a woman has reached
menopause when she has not had a period for one year.

15. Premenopause:
Premenopause is when you have no symptoms of
menopause. You still have periods, whether they are regular
or irregular and are considered to be in your reproductive
years. Some hormonal changes maybe occurring, but there
are no noticeable changes in your body.
Postmenopause:
This is the name given to the period of time after a woman
has not bled for an entire year (the rest of your life after
going through menopause). During this stage, menopausal
symptoms, such as hot flashes may ease for many women

16. METHODOLOGY
 Study Design: Comparative cross sectional
study
 Settings: University of Lahore Teaching
Hospital.
 Duration of Study: 4 months
 Sample Size: 326 women with dry eye
symptoms, divided into two groups of pre
and post menopause 164 in pre and 162 in
post each.

17. SAMPLING TECHNIQUE
 Sampling Technique:
Non-probability convenient sampling technique
Sample Selection:
 Inclusion Criteria:
Women between 40 to 70 age Group.
 Exclusion Criteria:
 Other ocular diseases i.e blepharitis,ectropion causing dry eye.
 Systemic diseases i.e Sjogren syndrome, xerophthalmia , pregnancy, thyroid
disorder, diabetes etc causing dry eye
 Smoking
 Women with surgically removed uterus due to any gynecological problem.

18. Equipment:
 Schirmer strips,
 Watman filter paper no.41,
 Anesthetic drops,
 Torch,
 Ophthalmoscope

19. ETHICAL CONSIDERATIONS
 Rules and regulations set by UOL - will be followed
 Data collection kept confidential and will not be
shared with any one.
 Participants
o briefed before the study
o kept anonymous
o informed that no disadvantage or risk involved
o can withdraw from the study
 Data will be kept in under password in computer
19

20. DATA COLLECTION
PROCEDURE
 Approval was obtained from the IRB (Institutional Review Board) of
University of Lahore.
 On the day of data collection, subjects fulfilling the inclusion criteria were
selected by purposive convenient random sampling after obtaining informed
consent. In case the patient denied, the next patient was selected for interview
and examination.
 Information about socio-demographic characteristics was collected by
pretested questionnaire. The questionnaire included information about age,
sex, occupation, educational status.
 The questionnaire was design after reviewing multiple literatures. For
accuracy of the data most questions are close ended questions.

21. DATAANALYSIS
PROCEDURE
The data was analyzed using Statistical
Package for the Social Sciences (SPSS)
version 20.0.
Chi square test was used to asses the
association between menopause status and
dry eye.

22. GANTT CHART
Activity
Months
(Divide the months according to your research duration)
01 02 03 04 05 06 07 08 09
Data collection
Data analysis
and
interpretation
Thesis
presentation
and
submission
(In order to achieve the desired objectives of the study,
divide your work plan into different phases in a tabular
form)

23. RESULTS
 Figure 1: Prevalence of Scratchiness and Grittiness in Premenopausal and Postmenopausal
Women
 Among 164 premenopausal women, 72.0% were having dry eye symptoms like
scratchiness and grittiness. Out of 162 postmenopausal women, 46.9% were feeling
scratchiness and grittiness. Results obtained were significant as p value <0.05

24. Figure 2: Prevalence of Excessive Watering in
Premenopausal and Postmenopausal Women
 Among 164 premenopausal women, 71.3% were having
excessive watering and out of 162 postmenopausal women,
46.9% were having dry eyes symptoms like excessive watering.
Results obtained were significant as p value <0.05

25. Figure 3: Prevalence of Eye Redness in
Premenopausal and Postmenopausal
 Among 164 premenopausal women, prevalence of eye
redness was 72.6%. Out of 162 postmenopausal women,
46.9% were having redness in eyes. Results obtained were
significant as p value <0.05

26. 1.Association Between Status of Menopause
and Schirmer Test Results of Right Eye
 Out of 326 participants, 164 were premenopausal and
162 were postmenopausal women. Among
premenopausal 87.8% showed mild, 11.6% moderate and
0.6% severe Schirmer test results in right eye. Among
postmenopausal 7.4% showed mild, 44.4% moderate and
48.1% severe Schirmer test results in right eye. Schirmer
test results in pre and post-menopausal women were
significant as p <0.05 was obtained. Chi square test was
used for statistical analysis.

27. Table 1: Association Between
Status of Menopause and Schirmer
Test Results of Right Eye
Status_of_menopause SCHIRMER TEST RESULT OF RIGHT EYE Total P-Value
10-15mm(mild) 5-10mm(moderate) <5mm(severe)
Premenopause 144 (87.8%) 19 (11.6%) 1 (0..6%) 164(100%) 0.000
Postmenopause
12(7.4%) 72(44.4%) 78(48.1%) 162(100%)
Total
156(47.9%) 91(27.9%) 79(24.2%) 326(100.0%)

28. 2.Association Between Status of Menopause
and Schirmer Test Results of Left Eye
 Out of 326 participants, 164 were premenopausal and
162 were postmenopausal women. Among
premenopausal women 87.88% showed mild, 11.6%
moderate and 0.6% severe Schirmer test results in left
eye. Among postmenopausal 7.4% showed mild, 43.8%
moderate and 48.8% severe Schirmer test results in left
eye. Schirmer test results in pre and post-menopausal
women were significant as p <0.05 was obtained. Chi
square test was used for statistical analysis.

29. Table 2: Association Between Status
of Menopause and Schirmer Test
Results of Left Eye
Status_of_menopause SCHIRMER TEST RESULT OF LEFT EYE Total P-Value
10-15mm(mild) 5-10mm(moderate) <5mm(severe)
Premenopause 144(87.88%) 19(11.6%) 1(0.6%) 164(100.0%) 0.000
Postmenopause
12(7.4%) 71(43.8%) 79(48.8%) 162(100.0%)
Total
156(47.9%) 90(27.6%) 80(24.5%) 326(100.0%)

30. DISCUSSION
 Dry eye disease affect the eye health and vision in pre and post
menopausal women.
 Present study do not represent the true frequency of Dry eye
diseases seen in the community.
 There may be many more patients in the community with Dry
eye disease who may not have overt eye symptoms, hence do not
present to the hospital.
 But this study may provide some useful information on the
frequency of Dry eye diseases in pre and post menopausal
women.

31. CONTINUED
In previous similar study by coates Cf et al, post-menopausal
women were examined to find out the frequency of dry eyes.
Different ocular surface test such as Schirmer test with
anesthetic drops and corneal staining was performed on post-
menopausal women of different age groups.Results showed that
1/3 postmenopausal patient had dry eye.
Similarly to our study it has been shown that there is high rate of
dry eye in post-menopausal females due to significantly
decrease in tear film production

32. • A Comparative Research was conducted by Dr surabhi
Benewal et al between pre as well as post-menopausal
women to evaluate the DED.
• Between two groups different tests were performed such
as schirmer test, tear breakup time test and OSDI.
• Results showed that out of 75 postmenopausal women,
31 patients (41.33%) had dry eye and out of 75
premenopausal examined, 3 patients (4%) had dry eye
Similar to results of our research the results of this showed
that post-menopausal women have more prevalence of dry
eye.

33. CONTINUED…
 Pascual Garcia-Alfaro et, al. examined 1,947
women between October 2018 and January 2019
in NYC on a group of pre and post menopausal
women.
The authors concluded that 64% of pre and post-
menopausal women had OSD symptoms. OSD
symptoms and age, postmenopausal and earlier
age at menopause were correlated, which were
associated with increased prevalence.

34. CONTINUE
 Cross sectional descriptive study was conducted by Dr
AbdulKadir Turgut et, al. on Effect of menopause in Turkey in
2017.
In this study, 54 premenopausal and 54 postmenopausal
women participated.
 Similar to our study they concluded that the hormonal
abnormalities related with age lead to dry eye symptoms,
central corneal thinning particularly in postmenopausal
women.

35.  In the present study, no association was found
between age and the frequency of refractive
error. In this respect, results of this study were
similar with Ezinne who have reported that
age and the frequency of refractive errors
have no association.

36. CONCLUSION
 Diagnosing Dry eye diseases will increase the
awareness of the need for treatment, support
and encourage adherence to medication.
 New and innovative Strategies are required to
assess and diagnose these ocular surface
diseases and to establish early treatment
resulting in decreasing the Dry eye disease
burden.

37. PERFORNA/
QUESTIONNAIRE
Comparison of dry eye in pre and post menopause
University of Lahore Teaching Hospital UOL
Profile: Case no:……….
Name:………………………
Age……………………………………
Gender:
Occupation ………………………………...
Address
…………………………………………………………………………………………....

38. CONTINUED
Schirmer’s test
OD
OS
Signs/Symptoms Yes No
Premenopausal
Post menopause
Scratchiness or grittiness in eyes
Watering in eyes
Burning Sensation in eyes
Eye redness
Difficulty wearing contact lens
Difficulty with night time driving
Ocular surgery in past
Dryness in areas like vagina,
mouth or nose
Hot flashes
Mood swings
Sleeplessness

39. REFRENCES
1. Craig JP, Nichols KK, Akpek EK, Barbara Caffery OD, Dua HS, Joo CK, Liu Z, Nelson JD, Nichols JJ,
Tsubota K, Stapleton F. TFOS DEWS II - Report on Definition and Classification. Ocular Surface. 2017;
30: 276-83
2.Baudouin C, Rolando M, Del Castillo JM, Messmer EM, Figueiredo FC, Irkec M, Van Setten G,
Labetoulle M. Reconsidering the central role of mucins in dry eye and ocular surface diseases.
Progress in retinal and eye research. 2019 Jul 1;71:68-87.
3.Malkar U, Sodhani H. Menopause, A symptom of change!. InProceedings of the World Conference
on Women’s Studies 2019 Sep 11 (Vol. 4, No. 1, pp. 15-20).
4. Okumura Y, Inomata T, Iwata N, Sung J, Fujimoto K, Fujio K, Midorikawa-Inomata A, Miura M,
Akasaki Y, Murakami A. A review of dry eye questionnaires: Measuring patient-reported outcomes
and health-related quality of life. Diagnostics. 2020 Aug;10(8):559.

40. CONTINUE
 5.Rolando M, Zierhut M. The ocular surface and tear film and their dysfunction
in dry eye disease. Survey of ophthalmology. 2001 Mar 1;45:S203-10
6.Garcia-Alfaro P, Bergamaschi L, Marcos C, Garcia S, Rodríguez I. Prevalence of
ocular surface disease symptoms in peri-and postmenopausal women.
Menopause. 2020 Sep 1;27(9):993-8
7.Graue-Hernández EO, Serna-Ojeda JC, Estrada-Reyes C, Navas A, Arrieta-
Camacho J, Jiménez-Corona A. Dry eye symptoms and associated risk factors
among adults aged 50 or more years in Central Mexico. salud pública de méxico.
2019 Jun 10;60:520-7.